In Philadelphia, babies are also victim to the opioid epidemic | Expert Opinion

A 2-year-old came into the emergency room unconscious when I was a pediatric resident two decades ago.

My colleagues and I quickly ran through the A, B, C, D of emergencies, checking the boy’s airway, breathing, circulation, and disability/injury status.

He was breathing normally and showed no signs of trauma. We moved on to a glucose test and, finding dangerously low levels, started an IV.

As his mother squeezed him tight and he began to awaken, the boy’s father rushed in with a bottle of mouthwash, which contains alcohol, that he thought his son swallowed.

These days, a glucometer isn’t the first tool we grab when an unresponsive child shows up in the ER. We reach for naloxone, the overdose-reversing drug. A, B, C, D, N.

The opioid epidemic has not spared even our youngest patients. In our hospital, which borders the Kensington opioid markets, we are seeing over 60 infants a year exposed to opioids in utero.

From January to July 2023, we treated 17 infants and young children exposed to opioids, up from 13 in all of 2022 and one in 2015. We’ve treated kids who touched powdered opioids, then put their hands in their mouth. One child ate something laced with opioids.

In 2021, 40 infants under a year old and 93 children ages 1 to 4 died from accidental fentanyl poisoning, a sixfold increase from 2018, according to data collected by the National Poison Data Center and local Childhood Fatality Teams, which I am a part of.

An April 2023 article in Pediatrics showed that opioids were the most common substance causing death in children under 5 years old — triple that of cough, cold, and allergy medicines, which used to be the most common substance connected with deaths.

In 1970, the Poison Prevention Packaging Act required child-resistant packaging for many medicines, and hazardous products and deaths from poisonings in children decreased markedly. But that law hasn’t protected children from illicit opioids and xylazine, a non-opioid that is now contaminating much of the drug supply and causing horrific consequences.

We need to permanently classify as Schedule 1 all opioids that don’t have legitimate human medical use, such as carfentanil, an animal tranquilizer 100 times more potent than fentanyl. Schedule I drugs have high potential for abuse and carry extra warnings for patients and doctors intended to restrict use.

We need to have robust, accessible mental health services for those who are struggling with mental illness or untreated trauma, so they are less likely use substances to “treat” their disease. We also need readily accessible medication-assisted treatments for people who are ready to control their disease.

Naloxone should be widely distributed in schools, restaurants, and high-traffic public spaces. It should be on hand in homes and in community spaces. And training for how to use naloxone should be readily available.

We need a citywide effort to address poverty and “poverty of purpose” — insufficient opportunities for employment and social connections, and a lack of hope for finding them. Both can drive people to drugs to numb the pain and make money.

In the April Pediatrics article, the authors wrote that “as the landscape of the opioid crisis evolves, the development of pediatric-specific opioid response initiatives should be prioritized.”

In our hospital we are convening a task force for an effective, community-centered, sustained response that will teach people how to store and dispose of medication safely, and how to use naloxone. The task force is also developing a referral system for families affected by this epidemic.

We have partnered with Prevention Point and the City of Philadelphia’s Opioid Response Unit, but more importantly we are working with families affected by the opioid epidemic. We believe that those closest to the pain are also closest to the solutions.

Many of these resources can be obtained on Cap4Kids (cap4kids.org/Philadelphia), which include substance use resources for mothers and babies, free naloxone, doula programs, and many others.

The opioid landscape has changed for our children and communities, and we must have a collective, intelligent and compassionate response to this epidemic, or continue to watch as the waves of overdoses and the wails of ambulances and of parent’s cries, continue to pound on our emergency room doors.

Daniel R. Taylor is advocacy director at St. Christopher’s Hospital for Children. Norrell Atkinson is the director of the child protection team at St. Christopher’s Hospital for Children.